The eclipse came early. The insanity abroad has been eclipsed by insanity at home. White nationalists invaded Charlottesville this weekend and the country is bathed in darkness.

When the president attributed blame for Charlottesville to “many sides,” he demonstrated an alarming moral emptiness and intellectual vacuity.

We need presidential resolve and encouragement at such a moment of national crisis.

Much has been said about this overnight, including a retributory Tweet from the “Grand Wizard” himself, David Duke. Among all the critiques, this one is perhaps the most gut wrenching.

Duke attacks the President for his ambiguity, for being an ingrate to the White Nationalists “taking back America” in Charlottesville, for his failure to take their side and for failing to condemn instead the counter-demonstrators who opposed their efforts to “preserve” White History, White Culture and White Identity.

And it was not just about color, these white boys flew and wore both Confederate and Nazi symbols, spewed anti-Semitism, pulled down rainbow flags and rejected every individual and collective quality of a diverse, pluralistic society.

This is White Darkness indeed. It expects to be unleashed from “political correctness” and “in control” with the license and leadership of a bouffant-blond, Aryan-looking White President.

These defenders of White History are the “spiritual” and intellectual descendants of the white American immigrants who, among other things, robbed the indigenous peoples of their land, killed them off with guns and disease, stole Africans from their homes, pressed them into the holds of ships to be transported like animals from Africa, and precipitated the death of millions in a civil war fought over the abominable practice of slavery. They evoke the Nazi crimes of World War II, defend the Holocaust and justify other nationalist horrors of the modern era.

Yes, Mr. President, please do look in your mirror. These people voted for you, echoed your words this weekend and proudly wore your absurd MAGA hats while they hissed their hate and wreaked their havoc. You have enabled them and by your example and, by your silence, you have left them unshackled.

I hope these White Americans represent just a small number of the white Americans who voted for you. But every white American who did, should also look in the mirror, especially the mirror of history.

Our federal delegation seems to be failing us on one of the most important issues of our time: health care. For what matters most, they are doing least.

In response to my recent personal letter to Senator Crapo about health care, I received a “form letter,” email response. (What was I expecting?)

The response completely ignores the issues I raised and reads like an apology for the heartless legislation now before the Senate. [Senator Crapo’s email is copied verbatim below.]

No mention of the CBO scoring that shows tens of millions will lose health coverage under any version of the Senate legislation.

No mention of the disproportionate impact on Idaho, because of our already shameful “coverage gap” and the likely losses to already-stretched medical services in our far-flung rural communities.

No mention of the disproportionate benefit of tax cuts for the wealthy at the cost of the poor.

No acknowledgement that the problems of the current law can be traced to conservative, compromise provisions inserted in the Act; the virulent Republican opposition since; and, the new administration’s squeezing off of legally-mandated support in an effort to force failure–which is like a “caregiver” pressing a pillow over the head of a struggling hospital patient.

Senator Crapo’s email response makes clear the opposition to the current law (the “PPACA”) is based on the right-wing imperatives of unfettered markets and lower taxes. Facts, logic and a concern for the health of society (and our state) do not seem to matter.

For Idaho and Idahoans, this may be the most impactful decision our Senators ever make. Unfortunately, like lemmings (and our Congressmen before them), they appear to be following the partisan crowd in their “rush to the sea.”

In a show of courage, Senators Crapo and Risch should pull back their support and advocate for collaboration with the rest of the Senate (the whole Senate) to find ways to improve the PPACA.

I hope they will muster the courage. Sadly, Senator Crapo’s apologia does not give me much hope.

Senator Crapo’s response to my letter:

July 21, 2017

Jerry Sturgill
Boise, ID

Dear Jerry:

Thank you for contacting me about health care reform. I value the constructive thoughts, opinions, and ideas shared by all Idahoans and welcome this opportunity to respond.

Prior to the implementation of the Patient Protection and Affordable Care Act (PPACA), America’s health care system was in need of reform; however, PPACA favors a one-size-fits-all, top-down approach that has led to increased premiums, smaller provider networks and stifled competition between insurers. It is necessary to work toward implementing consumer-driven, state-based health reforms that ensure the American people have access to the health care coverage that is right for them. On May 4, 2017, the U.S. House of Representatives took the first step toward comprehensive health reform by passing H.R. 1628, the American Health Care Act.

The Senate is currently considering various proposals to repeal and replace PPACA. Any successful reform initiative must include provisions that stabilize the insurance market, repeal the individual and employer mandates and job-stifling PPACA taxes. With premiums rising and coverage options disappearing, the status quo of PPACA is no longer an option.

Congress remains actively engaged with governors, stakeholders and consumers to develop an effective system that works for all Americans. America deserves a better process and a better product, and I look forward to doing my part to make this happen.

In the meantime, please feel free to continue to contact me about health care reform or on other matters of interest to you. For more information about the issues before the U.S. Senate as well as news releases, photos, and other items of interest, please visit my Senate website, http://crapo.senate.gov.

In past blog posts, I have offered many arguments against “repeal and replace” and the American Health Care Act. Here’s a recap.

The purpose of health insurance is to spread costs and risk. The Affordable Care Act (“ACA” or “Obamacare”) does this by requiring everyone not covered by Medicaid or Medicare to have access to health coverage, with subsidies for those who cannot afford it and penalties for those who “opt out.”

The costs of subsidies and Medicaid expansion have been paid by taxes on the very rich.

It is no surprise that political opposition to the ACA has been funded by people who are very rich–and the insurance industry, where very rich people are stockholders.

Health insurance premiums would have come down if conservative opposition had not hobbled the ACA from the beginning and there had been greater incentive for younger and healthier people to remain in the “risk pools.”

While the ACA’s mandate and subsidies have been the target of much opposition, these were conservative concepts and implemented in Massachusetts “Romneycare,” a conservative model for the ACA.

The continuous opposition to the ACA and the post-election efforts to undermine its mandate and subsidies have further disrupted the health insurance exchanges and driven up health insurance costs. This has been a concerted effort to prove the arguments against the ACA.

In other words, the ACA has been in the hands of its enemies and they have purposely weakened it to justify their efforts to “repeal and replace.”

The current House and Senate versions of the American Health Care Act (“AHCA” or “Trumpcare”) will not solve these problems now intensified by the conservative opposition. The markets will continue to be disrupted and premiums will continue to rise. Worse, tens of millions of working Americans will lose health insurance coverage.

It might feel good to conservatives to strip the working poor of “entitlements,” but this only leads to more poverty and homelessness, which come back to bite us all.

We all ultimately pay the price through increases in our own health care costs and taxes, as the poor are left again to resort to emergency care. Drug use and crime rates will rise. Productivity will decline. The negative cultural and economic impacts will be real and hard to quantify.

On the other hand, everyone benefits from the preventative measures, coordination of care and other measures enacted under the ACA. With these measures, health costs would continue to go down. Productivity will continue to rise. We will all be better off.

An ounce of prevention can ultimately be worth more than a pound of cure.

The AHCA will do nothing to make our current system more efficient. It is estimated that there is more than $350 billion of duplicated costs and waste in the system. Not to mention profit-taking. Because of these “burdens,” we pay more than any other developed country for health goods and services and we get worse results.

The political focus should be on making the current system under the ACA more efficient, squeezing out costs and making health care more affordable for everyone.

The AHCA (Trumpcare) is NOT the solution. If the health care system is like a car, Trumpcare will be like dumping bags of sugar into the tank, instead of improving performance with a tune up and better gasoline.

There is good reason for skepticism about our federal delegation. Even so, today I have mailed and emailed this urgent letter to Senator
Crapo.

Dear Senator Crapo,

On election night, when I called to congratulate you on your victory, you were gracious, told me of your working with and listening to both sides of the aisle and accepted my offer to be in touch for moments and matters of importance to Idahoans

This is one of those moments. The matter is health care.

H.R. 1628 “The Better Care Reconciliation Act” currently before the Senate will have a devastating impact on many Idahoans. I respectfully implore you to oppose it.

The predicted problems with this legislation are compounded for Idaho in the fact that 78,000 Idahoans already have suffered for years without health care coverage, in large part because the Idaho State Government refused Medicaid expansion under the Affordable Care Act (ACA).

Idaho’s Coverage Gap will grow and access to health care will become even more unattainable with the Medicaid contraction and rising premiums predicted by the CBO.

I recently received this note from someone already in the Idaho Coverage Gap:

“Jerry, it’s a sad state of affairs. I am one of the 78,000 here in Idaho. I don’t want something for nothing, but just can’t do the premiums. And it is obviously going to get worse.”

You and I have both served as Bishops in our church. My ward is unusual in that it takes in the downtown area of Boise and the largest concentration of emergency housing for the homeless in Idaho. Our ward also has a large swath of Section 8 housing.

Because of my experiences at Church and after the election, I joined the board of the Interfaith Sanctuary, one of the three large homeless shelters in Boise and the only one that accepts families.

In these roles, I have worked with (and conducted funerals for) the most vulnerable in our community and learned of the mental and physical problems that led to their homelessness and, like an iron boot, kept them there.

Access to health care through Medicaid is often the only thing that gives hope and the possibility of returning to productivity.

The coverage contractions and increasing premiums caused by the BCRA will only result in more homelessness, loss of hope and a growing social burden and responsibility.

In this divisive and individualistic political and cultural environment, I hope you will apply our shared values to encourage care for our poorer brothers and sisters.

The ACA was meant to do that, by spreading the risks and costs of health care to as many as possible. (We all share the costs and risks of driving with car insurance! Why not health care?)

After strenuous and constant opposition, the ACA mandate is reportedly “hated,” but the fact is that without it (or increased taxes) more people will suffer the effects of poverty and the crushing unavailability of health care—at a cost to all of us.

Consider, for example, the statistics that show where Medicaid was expanded, the costs of emergency care went down. Otherwise, the costs of emergency care must be spread with increased taxes and higher health care prices.

For these and other reasons, the AHCA and BCRA have been characterized as “Rich Care” for some Americans rather than “Better Care” for all Americans. No surprise that recent polls show most Americans are against it.

This is not an area where deficit reduction or reducing taxes on the rich should be a consideration. A healthier society will be a happier, more productive society. Deficits and rich people will take of themselves.

Please vote against the BCRA and collaborate with both sides of the aisle to fix the ACA or otherwise spread risks and costs to make health care fair and affordable for all Idahoans and all Americans.

Thank you for your kind consideration and your continued service.

Sincerely,

Jerry Sturgill

P.S. Please feel free to share this message with Senator Risch. I look forward to being in touch again on future topics, like tax reform, immigration, climate change and public lands.

There is solid logical and factual basis for opposition to the “repeal and replace” legislation passed by the House and now before the Senate.

Logic first.

Barring accident, taking preventative measures leads to better health and reduces the risk of future catastrophic illness. Such measures include annual checkups, better diet, exercise and seeing the doctor when symptoms first appear.

Putting off prevention can lead to escalating problems and higher costs, like putting off repairing a few shingles in your leaky roof until the whole roof collapses. The logical result is wider damage and higher costs.

Most people, including me, tend to wait because of cost.

In my case, I could have avoided years of discomfort and permanent damage if I had not had a high deductible plan and put off seeing the doctor. Rather than spend the money, I lived with the symptoms, with the self-deception that they might go away.

Logically, these tendencies are especially acute among poor working families, who tend to serve more immediate needs — like food and shelter — instead of spending time and money seeking medical advice.

If you cannot identify with this, you must be really lucky. You should consider volunteering at a homeless shelter.

Now the math.

The data referred to in my last post simply confirms the above logic and puts numbers to the effects of health insurance contraction under the American Health Care Act (AHCA or “Trumpcare”).

If you want to dig into the numbers, look at the data from Idaho that describe the 78,000 uninsured who do not qualify for coverage — because they make too much to fit the narrow qualifications in Idaho for Medicaid and not enough to qualify to participate on the “Your Health Idaho” individual insurance exchange. This is the estimated number of Idahoans in the “Idaho Coverage Gap”.

CBO has quantified what is obvious in the legislation: the Senate bill would eliminate coverage for 15 million Americans next year and for 22 million by 2026; cut Medicaid by $772 billion over the same period; next year increase individual market premiums by 20 percent; and, make comprehensive coverage “extremely expensive” in individual markets.

According to the KFF analysis, an estimated 4.5 million uninsured adults live in the states that did not accept the expansion of Medicaid under the Affordable Care Act (ACA or “Obamacare”). Of that number, an estimated 52,000 live in Idaho. These are Idahoans who would have been covered under the ACA, but missed the opportunity because of the Idaho government decisions to not accept Medicaid expansion dollars and to sponsor its own individual exchange. (Whatever the exact number, it includes some or all of the 78,000 in the Idaho Coverage Gap.)

What are the health impacts? The study sponsored by the Harvard School of Public Health concludes that the availability of coverage in Massachusetts (the model for the ACA), has had the effect of improving public health reducing mortality rates. While demographics and health care resources in Massachusetts may differ from those of Idaho, it is significant that a well-constructed, scientific study has concluded that 830 human adults obtaining previously unavailable health insurance coverage could prevent at least one death per year.

The next step is my own analysis of this data and required mathematical extrapolation. It is indicative only (meaning that it is simply an illustration) of the logic at the beginning of this post and my last post.

My analysis assumes that if the AHCA is passed by the Senate after the July 4th recess, its impacts would apply equally across the Idaho population, which represents around one-half of one percent of the total U.S. population. It assumes that Idaho on its own does not find a way to close the Idaho Coverage Gap. (Efforts so far have failed.) And, it assumes the Harvard Study results could apply to Idaho across the board to all who lose coverage. With those assumptions:

Between 125,000 and 150,000 people will lose coverage in Idaho within the next decade.

Between 150 and 180 people are more likely to die as a result.

This analysis has been dismissed as “hysterical.” Our own Congressman, Mr. Labrador, attracted national and international news coverage when he said that lack of access to health insurance does not result in death.

Paul Ryan has also tried to spin the CBO data by saying that the “loss” of coverage under the AHCA is simply people opting away from buying health insurance in the absence of the “freedom robbing” mandate.

His argument ignores the fact that the largest negative impact on coverage under the AHCA is Medicaid contraction. His argument is also like someone in the Medicaid gap saying he or she would choose to buy a BMW but exercises the freedom not to do so.

While I am aware that we live in a world of “alternative facts,” please understand that I have done my best to discern and share sound logic and credible facts.

Our Senators must have courage, beginning this week, to resist partisanship and stand up against the devastating effects the Senate version of the American Health Care Act (“Trumpcare”) will have on Idahoans.

Why such a partisan divide on health care? Why did the House pass a bill that will put health insurance beyond the reach of 23 million people? Why have Republican Senators scurried off to work in secret on the Senate version of the bill?

According to the Times, “Now Mr. Heller is facing an intense backlash in Nevada, his home state, where there is talk of a primary race challenge against him next year and a pair of the state’s wealthiest Republican donors are fuming.”

The leading edge of the “backlash” is from President Trump and his rich supporters, in this case, billionaire Nevada casino magnates, Sheldon G. Adelson and Steve Wynn.

Meaning, the health care fight is largely over the taxes imposed on the wealthy to make health insurance affordable for the poor.

Money versus health. Greed versus individual and societal well-being.

Notwithstanding attempts by Republicans, including Raul Labrador and Paul Ryan, to explain otherwise, if the Senate version of Trumpcare passes, 22 million Americans will become uninsured and people will die.

A Harvard medical study published in the New England Journal of Medicine showed that for the states that adopted the Obamacare Medicaid expansion, mortality rates have declined. Many previous studies support the same, obvious conclusion that with access to health care, mortality rates decline — including for young people.

Voting for Trumpcare is like voting to strip most of the Boise metro area of health insurance and allowing one whole neighborhood to die as a result.

Because of their disregard for the lives of their constituents, Raul Labrador and Mike Simpson should be ashamed for their votes in favor of the House version of the bill. Senators Crapo and Risch should be ashamed if they support the Senate version.

If you agree, please call or send emails to Senators Crapo and Risch. The Senate will come back to this terrible bill after their July 4th recess, so email as soon as you can. Encourage our Senators to follow Nevada Senator Heller’s example.

One night in New York City, I happened upon a mafia hit, the result of competition for leadership of the Gambino crime family. Current events take me back to that night.

After law school I worked as a corporate finance lawyer at a prominent law firm and spent 10 years in the firm’s New York City office.

My wife and I had both grown up in the West and, to us, the East had always been distant and forbidding.

“It will be an adventure!” I said to her cheerfully. “We’ll spend a couple of years out there, and then move back West.” She glared at me.

I went out ahead to work and look for housing. For a week or so, I wandered Manhattan in the evenings, searching for an affordable apartment.

On one of those nights, as I made my way back to my humble Lexington Avenue hotel, I passed Sparks Steak House on 46th Street, close to Third Avenue.

It was the night “Big Paulie” Castellano, head of the Gambino crime family, was gunned down on his way to dinner. Police tape closed off 46th street. Lights were flashing. Sirens blared. Bodies were still lying in the street, covered with sheets.

John Gotti, who had ordered the hit, would become head of the Gambino family. Guess he thought he could do a better job than Castellano.

“Better not tell my wife about this,” I thought, as I skirted the crime scene.

This was a dramatic introduction to an ugly part the City at that time. The mafia was distinctly present and projected an image of being above the law, cocky, arrogant and unrepentant. Just look at this mug shot of John Gotti.

At that time, some in the New York business world seemed to have inherited mafia-like arrogance, rudeness and winner-take-all attitudes. They showed little concern for relationship and trust. In negotiations, I experienced their blatant misrepresentations, threats, verbal abuse and crudeness. This always injected stress, distrust and delay in the transactional process.

At law school, in my business negotiations class, I had learned that a negotiator will more quickly achieve optimal outcomes with a collaborative approach. Humility, listening, honesty and respect build trust, foster cooperation and reach mutually beneficial outcomes.

In the face of the belligerent, bullying New York business style, I consistently applied what I had learned in school. My team succeeded in getting hard things done quickly and our practice grew.

This experience keeps coming back to mind (and you can probably guess where I am headed with the story).

I shudder watching from afar the negotiation style of our new President. So far, his lurching administration has left more bodies “lying in the street” than John Gotti.

This approach to “winning” shows little regard for the “other side,” or the greater good, and, with huge arrogance and a small attention span, fails to understand issues, details, process or people. It is, to me, mafia-like and poisonous to the political setting.

Our governing institutions, with checks and balances, exist to reach collaborative solutions and achieve optimal outcomes for the whole country, without regard to political party, group identity, winners or losers.

As citizens, we must demand collaboration and resist the “me-first” attitudes promoted by the new administration and worse-than-ever partisanship.

Those attitudes are causing our country, and the world, to become more fearful, angry and divided—and more dangerous and dispirited than ever.